A proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would expand the use of telehealth may directly benefit skilled nursing facilities (SNFs).
If adopted, the rule would allow CMS to pay clinicians for brief virtual check-ins and for evaluating photos that patients submit. It also would expand Medicare-covered telehealth services to include prolonged preventive services. (See a fact sheet.)
A recent article in Skilled Nursing News quoted several experts, including CAST Executive Director Majd Alwan, Ph.D., who say these guidelines point to the possibility of broader coverage for nursing homes. “This is certainly a step in the right direction,” said Alwan in "Operators, Telehealth Providers See Skilled Nursing Promise in New CMS Proposal."
The virtual check-ins would include phone conversations, e-mails, or texts sent through a patient portal with nursing home medical directors, primary care physicians, and other doctors or nurse practitioners, Alwan told Skilled Nursing News.
“These types of providers, physicians, can now take or return calls initiated by nursing home, AL [assisted living], or CCRC staff on behalf of patients to talk to them about their medical concerns, including management of opioid medications,” he said.
Another expert, Tapestry Telehealth COO Mordy Eisenberg, said that CMS may expand telehealth coverage beyond rural skilled nursing facilities, now about a third of nation's 15,000-plus SNFs, once they begin seeing telemedicine's results.
Tapestry saw its first patients in January and now operates in 23 rural nursing homes. Eisenberg expects that virtual visits could help prevent hospitalizations. By avoiding rehospitalizations, a building could earn back its automatic 2% reduction in Medicare under the SNF Value-Based Purchasing Program that goes into effect this fall, said the article.
In addition, telemedicine enables rural facilities to keep residents at their facilities. Now, rural providers often must pay for expensive municipal ambulance rides to take residents to faraway hospitals. Residents may never return; instead, they may be discharged to an SNF nearer the hospital or surgical center.
Eisenberg also said that telemedicine across all of a provider's buildings—not just the rural ones that Medicare currently covers—could enable a provider to consider an Institutional Special Needs Plan (I-SNP) internally or via a third party, or bundled payments.

Additional Pros and Cons

Other telehealth advocates discussed the rule’s pros and cons in a Healthcare Informatics article

Krista Drobac, executive director of the Alliance for Connected Care, described the proposal as creative and brilliant. Yet she also expressed concern that if CMS pays for brief e-visits, providers may weigh whether it is worthwhile to invest in telehealth systems.
Mei Wa Kwong, executive director of the nonprofit Center for Connected Health Policy, asked if CMS were creating communication technology as separate from telehealth. The current proposal requires providers to have a telehealth system. “But CMS asked for comments on whether they could be done on the phone, which I think would be a lot more common,” Kwong told Healthcare Informatics. With a reimbursement of $14 per check-in, she is unsure if physicians would think it worthwhile given the needed administrative tasks.
Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), praised the expansion of telemedicine yet questioned the criteria and payment amount. The additional telemedicine provisions “can be quite useful, as long as the complexity and the rules and the hoops you have to jump through are not overwhelming so that the return on investment to even provide those [telemedicine services] is there,” he said.

CAST agrees with these experts and encourages providers interested in telehealth and remote check-ins to submit their comments directly and/or share with LeadingAge CAST. Comments to the rule are due Sept. 10, 2018.